ECT patients under anaesthetic for two days

By Nicky Phillips

MENTALLY ILL patients in NSW have been anaesthetised continuously for more than two days in order to undergo court-ordered electroconvulsive therapy (ECT), in cases that have divided psychiatrists.

At least two patients have had the treatment, forcing NSW Health to formalise how it gives permission for psychiatric treatments which fall well outside normal practice.

"Slippery slope" to more radical treatment ... ECT requires a patient to be unconscious during the administration of an electric shock to the brain.Credit:Tanya Lake

Last year the then government set up a discrete panel to rule on the legality of individual cases amid concerns about a rise in forcible treatment.

A Sydney psychiatrist, Antonella Ventura, prescribed the lengthy treatment for a patient with extreme mania, behavioural disturbance and aggression.

Advertisement

According to a presentation abstract Dr Ventura co-wrote for the Royal Australian College of Psychiatrists conference last year, the patient had been paralysed and unconscious, requiring ventilation for a period of more than 48 hours and had been looked after in intensive care.

"There are times when ECT can be the safest and most humane treatment because it can produce a very rapid improvement in situations that are dangerous and distressing for the consumer and for health staff,'' Dr Ventura said.

"It allows the use of much lower doses of medication than would otherwise be necessary".

The treatment decision had been made by intensive care doctors and herself, in consultation with the state's chief psychiatrist, John Allan. Associate Professor Allan will chair the health department's expert review panel, which, if approved by the government, will rule on the suitability of the treatments.

He said they were very rare.''The mental health act allows appropriate treatment for the situation, so it certainly allows you to give sedation,'' he said. ''It requires you to be safe so when you get to a certain level of sedation you could call on an anaesthetist to help.

''When you're manic you can absorb enormous amounts of sedation".

But a former president of the Royal Australian and New Zealand College of Psychiatrists, Jonathan Phillips, cautioned against putting a patient under such lengthy anaesthesia to deliver ECT - which requires a patient to be unconscious during the administration of an electric shock to the brain.

ECT patients were typically anaesthetised for between two and five minutes.

''Forty-eight hours is a long time to be unconscious," he said. "I would warn against any treatment as radical as that when we know just about every patient with acute mania, which is relatively rare, can be dealt with by other means."

He was concerned such treatments could be the start of a "slippery slope" for even more radical treatment and said more details were needed on how consent for the procedure was given.

A patient needs to give informed consent for ECT. Where the patient is unable to, ECT must be approved by the Mental Health Review Tribunal, an independent body which reviews involuntary patients.

Greg James, QC, the president of the tribunal, said it must be satisfied the ECT was reasonable treatment, necessary for the safety or welfare of the patient.

The Mental Health Act of NSW states a maximum of 12 ECT treatments can be given to a person in a six-month period but says nothing about the duration of anaesthesia.

Mr James said the tribunal approved ECT if it was given in the ''usual'' way, which did not involve lengthy anaesthesia.